The University of Pennsylvania's (Penn's) International Core proposes to support two clinical research sites in Sub-Saharan Africa, one located in Botswana, the other in Malawi. Penn faculty from the School of Medicine have been involved in clinical and educational activities in Gaborone, Botswana since July 2001, and have recently initiated patient-oriented research protocols. Penn faculty from the Department of Sociology have been involved in studies in rural Malawi that address behavioral responses to the HIV/AIDS epidemic. This proposal joins the two groups of Penn investigators and uses CFAR resources to enhance reseach programs in Sub-Saharan Africa. Our Specific Aims are: Aim 1. To support the development of strong clinical and behavioral research programs in Botswana and Malawi involving collaborations between Penn and African investigators. Examples of research protocols planned include: Effects of pulmonary tuberculosis on parameters of HIV viremia and immune reconstitution in HIV infected subjects; Virologic effectiveness, predictors of virologic failure and development of a clinical prediction rule for virologic success in the Botswana National Antiretroviral Therapy Program; Effectiveness of informed consent procedures in rural Africa; Effectiveness of counseling on STD risk management; and Defining prevalence and incidence of HIV infection and evaluating impact of STDs on HIV acquisition in rural Malawi. This grant proposes to establish the research infrastructure, including establishing a patient database and specimen repository, to enable these protocols to be accomplished. Aim 2. To train investigators from Botswana, Malawi and Penn who are interested in international research. Investigators will be trained using the expertise of CFAR investigators and the resources of the Center for Clinical Epidemiology and Biostatistics. African investigators will have the opportunity to train at Penn or to be supervised by experienced Penn investigators who travel to Africa to train on site. The International Core proposes to expand Penn's involvement in International Medicine. The School of Medicine is making a major commitment to clinical and educational activities in Botswana. This proposal seeks to fill a void in Penn's HIV program by promoting international clinical HIV/AIDS research, which is critical for control of the global HIV epidemic.